December 2000

RESEARCH ADVANCES

Gender Differences May Affect Substance Abuse Treatment Retention
A team of researchers affiliated with Kaiser Permanente Medical Care Program
in Oakland, California, has identified some gender-based differences in retention
rates between men and women in outpatient programs treating alcohol and drug
abuse. The researchers followed 317 women and 599 men who were admitted
to the HMO program during a 2-year period. Among the findings:

Men are more likely to complete treatment for drug or alcohol abuse if they are
--over age 40,
--in treatment at the suggestion of an employer, rather than a family member, or
--striving for abstinence.

Women are more likely to complete treatment if they are
--in the $20,000-or-higher income bracket,
--part of an ethnic category other than black,
--unemployed, or
--married.

WHAT IT MEANS: Factors that influence patients' decisions to drop out of
substance abuse treatment differ for men and women. Recognizing these
differences may help clinicians identify those at risk for dropping out and
help them tailor programs to improve retention and treatment outcome.

This study was published in the October issue of Alcoholism: Clinical
and Experimental Research.

RESEARCH NEWS

Craving for Cocaine Involves Same Brain Sites as Other Cravings
Craving for cocaine--an often irresistible urge that can be triggered by
environmental cues linked to past drug use (being with certain people or
in a certain location)--is associated with the same brain circuits that are
involved in response to other, nondrug stimuli.
Scientists at the Medical College of Wisconsin in Milwaukee showed
4-minute films depicting drug use, nature scenes, or explicit sexual activity
to cocaine users and to participants with no history of cocaine use.
In particular, both users and non-users reported similar levels of arousal
while watching the sex film, and functional magnetic resonance imaging (fMRI)
revealed similar patterns of regional brain activation in both groups. Most regions
identified as cocaine craving sites were similarly activated by sexual stimuli,
indicating that common circuits are involved in drug and nondrug responses.
Lead investigator Dr. Elliot Stein notes that in response to the sex film, drug users showed less activation
in these sites than did the non-users. This suggests that cocaine craving not only acts on the brain's
reward circuits, it actually co-opts them, changing the user's normal emotionally driven preferences.
According to Dr. Stein, this may have serious consequences for decisionmaking by cocaine users.
There were no differences between users and non-users when they viewed the nature film.

WHAT IT MEANS: The brain sites involved in cocaine craving are associated with emotional
response, information processing, and working memory. What is already known about normal
learning, memory, and emotions may be applied to cue-induced craving and the development
of appropriate pharmacological, behavioral, and cognitive therapies.

Dr. Stein and his colleagues describe their research in the November issue of the
American Journal of Psychiatry.

NIDA Funds Innovative Research Facility To Enhance Social Workers' Involvement in Substance Abuse Treatment Research
NIDA has awarded a 5-year, $1.9 million grant to the George Warren Brown School of Social Work at
Washington University in St. Louis, Missouri, to fund the first drug abuse research infrastructure program.
This effort will lead to the development of social work-led multidiscipline studies targeting the problem
of the dually diagnosed, addiction and mental health and/or HIV/AIDS-afflicted underserved populations.
Arlene R. Stiffman, Ph.D., professor of social work, will head the school's Comorbidity and Addiction,
Prevention, Intervention and Treatment Research Program (CAP-IT). She says, "The NIDA-sponsored
infrastructure development program provides an unprecedented opportunity to conduct cutting-edge
research that will enable social workers and other allied health professionals to make a quantifiable
difference in helping people with substance abuse problems. The majority of substance abuse services
are in sectors where social workers are in the trenches, putting social workers in a unique position to
address the complexity of addiction and HIV risk problems."

The five inaugural pilot projects of this grant will focus on research that looks at:
n The cost and the role of nontraditional services for adolescent American Indians with
addiction problems;

An intervention treatment program for homeless people with both mental health and
substance abuse problems;

Solvent abuse and dependence among St. Louis-area drug-using populations;

To order publications in English or Spanish, call NIDA’s new DrugPubs Research Dissemination center at 1-877-NIDA-NIH (1-877-643-2644) or 240-645-0228 (TDD), or fax or e-mail requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at drugpubs.drugabuse.gov. NIDA’s new media guide can be found at drugabuse.gov/mediaguide.

The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department
of Health and Human Services. NIDA supports more than 85 percent of the world's research on the health
aspects of drug abuse and addiction. The Institute carries out a large variety of programs to ensure the
rapid dissemination of research information and its implementation in policy and practice. Fact sheets on
the health effects of drugs of abuse and other topics can be ordered free of charge in English and Spanish
by calling NIDA Infofax at 1-888-NIH-NIDA (644-6432) or 1-888-TTY-NIDA (889-6432) for the deaf. These
fact sheets and further information on NIDA research and other activities can be found on the Home
page at http://www.drugabuse.gov.